Transcript The Pines_BID Med Pa..

BID Med Pass Project
Michael D. Crowley, MD, FAAFP,CMD
Joan Gannon, RN, CDONA/LTC
Stacey Radcliffe, MGS, NHA
The Pines Center
Genesis Healthcare Corporation
Long Term Care Medicine – 2011  March 24-27, 2011  Tampa, Florida
Unchain Your Nursing Staff!!
Learning Objectives:
 Describe the value of a BID Med Pass
System
 Explain how the clinical team can accomplish
this initiative
 List ways this process can
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Increase compliance with regulatory codes
Enhance staff performance
Positively affect every day routine for staff
Increase staff and resident satisfaction
BID Med Pass – Project Definition
A BID Med Pass Schedule is developed to
consolidate medication administration times for
long term care patients, where clinically
appropriate, to minimize unnecessary
medications and the numbers of medications
which require administration outside this
schedule.
Quality Improvement / Quality of Life
Project
 How many times do we approach a resident for
medication administration? An example:
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Colace 2x/day: 9am & 5pm
Seroquel at bedtime: 9pm
Nifedipine qd: 9am
Alphagan tid: 6am-2pm-10pm
Natural Tears qid: 6am-12pm-6pm-12am
 6am-9am-12pm-2pm-5pm-6pm-9pm-10pm
8 times / day
Quality Improvement / Quality of Life
Project
 Decrease daily interruptions for the residents
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Improve sleep
Fewer therapy or activities interruptions
Reduce “wait around” time for med administration
 Increase nursing time spent for
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non-medication related care and time spent with
residents
supervision and support of staff
 Reduce unnecessary meds / ADR potential
 Increase Resident and Family Satisfaction
BID Med Pass – How did we do it?
Achieving success requires
 Team effort
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Administrator
Director of Nursing/Assistant Director of Nursing
Medical Director, Nurse Practitioner, Attending
Physicians
Consultant Pharmacist
Nursing Staff and Certified Medication Aides
Regional Clinical Services Manager
 Measured approach – one unit at a time
 Communication with all stakeholders
BID Med Pass – How did we do it?
 Review each patient’s Medication Record for
 Rescheduling meds according to new med pass times
 Duplicate drug therapy, ineffective drugs
 Safe changes of TID and QID orders to long acting BID
dosage forms, if available
 Reschedule BID, TID and QID orders to maximize overlap
 Close review of drug regimens to eliminate unnecessary
drugs/dose, ensure gradual dose reductions
 Optimize resident specific needs, eg. timing of tube feeding
 Close and constant collaboration with physicians
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Pre-change Discussion; Chart Documentation
Follow up with effect of change (+ and -)
BID Med Pass: Our Example
 How many times do we approach a resident
with medication administration post BID Med
Pass?
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Seroquel at bedtime: 9pm
Nifedipine qd: 9am
Change BID Colace to Senna plus at
bedtime: 9pm
Change Alphagan tid times: 9am-2pm-9pm
Decrease Natural Tears to tid: 9am-2pm-9pm
(eliminate 12pm dose)
 9am - 2pm - 9pm
Reduced from 8 to 3 times per day
Results of Our Efforts
 Three LTC Units – 115 Residents
 101 Medication Regimens Converted or
Consolidated to a BID Schedule
 88% Conversion Rate
 Remember - All medications may not “fit”
Results of Our Efforts – Rx #s
Avg # Rx/Pt/Mon
Change in Avg # Rx/Pt/Mon with BID Med Pass
Project = 12.1 to 9.5
15
14
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2
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June
December
June 2010 vs December 2010
Results of Our Efforts – Staff Time
Before Implementation of BID med
pass project
Medication Pass
Lunch/Break
Documentation
Assist other Nrsg
Assistants with
patient care
After implementation of BID med pass project
Medication Pass
Lunch/Break
Documentation
Direct Patient Care
BID Med Pass Benefits
 Regulatory Compliance – Recent Survey
Results
 Quality of Patient Care Services – Improved
Customer Satisfaction by 8%
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Positive Resident Council Reports
 Care Giver Model Initiated with Additional
Staff Hours
 Enhanced Dining Program
 Improved Staff Satisfaction by 12%
 SUCCESS!
BID Med Pass – Not a Financial
Improvement Project BUT
Project Implemented April - June 2010
 Avg Medication Cost Per Pt Per Month
 6 Mon Avg Ending June 2010 = $419/Pt/Mon
 6 Mon Avg Ending Dec 2010 = $308/Pt/Mon
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↓ $110 Avg Medications Cost per patient per month
*Order data includes all payors (medicaid, medicare, insurance, pvt pay)
A smile says it all!
Questions?